Referral guideline – Epistaxis (recurrent)

Introduction

Epistaxis in children usually arises from Little’s area, on the septal wall anteriorly. Bleeding is usually venous, of brief duration and may be recurrent. Common predisposing factors include:

  •  mucosa – from upper respiratory tract infection, drying of mucosa, intranasal Minor trauma – from nose picking, rubbing, sneezing, coughing or straining
  • friable nasal steroids
  • rarer causes include foreign bodies, nasal polyps, bleeding disorders, vascular malformations, and nasopharyngeal tumours.

GP management

  • Address any obvious pre-disposing factors
  • Trial of antibiotic/steroid ointment or general moisturising ointment to anterior septum twice a day for some weeks
  • Acute bleeding usually settles with local pressure to the lower nasal septum

When to refer

  • Recurrent episodes of epistaxis continue despite conservative treatment above
  • Note: Acute epistaxis not settling with simple measures should be referred to the emergency department

Essential referral info

  • Presenting complaint and reason for referral
  • Detailed history of symptoms and treatment to date
  • Patient details (name, age and gender)
  • Medicare number
  • Parent/Carer’s name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Blood test results if available
  • Other past medical and surgical history
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, or alcohol/drug use in pregnancy
  • Family history
  • Current medications and allergies
  • Immunisations
  • Examination findings – including any dysmorphic features, full ocular examination
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Otolaryngology Head and Neck Surgery

Contact details

Hospital Switchboard
(Ask for Otolaryngology (ENT) On-call Registrar)
t: 07 3068 1111